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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
�-_ J State Fwm 43709 (RS / 4-03)
� I PreStribed by Depanment of Loral Govemment Finance
INSTRUCTIONS:
To 6e filed in person or by mail wfth the County Auditor of the county where the propeRy is located. ��, 7
Filing Dates: i) Real Property: During the 12 months 6etore May 11 0! the year the deduction is to be �ectAe.2 2006
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o/the year the deduction is to be effective.
See reverse side /or addilional instructions and qualificatior�s. �a� ��
/ �. GIBSON COUNTY q DITOR �
Applicant
Taxing Disirid
buyer-
���i(�l(.cQ/%� l L
Assessed value ofrealproperty as of
March 1, curtent year
Key number / legal description Record number
�6-ia -o,-vo3-oo�.sas-o�8 D 6
V. /�— D�� b S– �� Page number � b� �
Morigage / Contrad indebtedness unpaid as of Is the applipnt the sole legal or
March 1, wrrent year ownef? ❑ Yes ❑ No
�37Q�b
If no, what is his / her exaa share of interest?
If name on record is different than that of appiicant, indicate
�me of mortgagee or conlract seller
N� `�-- R_ S.
Address of mo gagee or contrad sefier (number
Name of assignee or other owner or holder ot mortgage
of assignee (num6erand street, city, state, ZIP
If owned with someone olher than spouse, indicate with whom.
state, ZIP
s the property in question:
❑ Real Property ❑ Moale Home QC Cr1.
Does appiicant own property in any other I If yes, what county? What Taxing Districf? Has this dedudion been requested on
county in Indiana? property for current yea(? � Yes ❑ No
Deduction approved in lhe amount
2� P I 2�
Signature _
r� I'
I
'^� �NTY AUDITOR
Dra tver. ��rp�Q
Q� .
C�r� �\'p .:.,�� -
County h,._. . �ate
20
We certify under the penalty of perjury that ihe above and foregoing information is true and coirect and that the applicants was / were
�esident o( Indiana and owner of the aforementioned property on March 1, 20
name)
Full
IN
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
authorized person